Provider Demographics
NPI:1508919507
Name:BENSON, BRENT WHITCOMBE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:WHITCOMBE
Last Name:BENSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3603
Mailing Address - Country:US
Mailing Address - Phone:307-587-1234
Mailing Address - Fax:307-587-4311
Practice Address - Street 1:931 13TH ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3603
Practice Address - Country:US
Practice Address - Phone:307-587-1234
Practice Address - Fax:307-587-4311
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY314146OtherBLUE CROSS BLUE SHIELD
WY20751Medicare ID - Type UnspecifiedPROVIDER NUMBER